GRACE WILSON
Dependent on policy B10M000690
Claims
3
Attributed to this person
Charged
1,637.00
Total submitted
Denied
0.00
1 denied claims
Patient responsibility
528.45
Reported on the 835
Patient responsibility is the amount reported on the 835 as assigned to the patient — deductible, coinsurance or copay. It is not proof that the provider billed the member, that the member owes it, or that it was collected, and it is kept separate from denied amounts throughout.
Who this is
| Field | Value |
|---|---|
| Name | GRACE WILSON |
| Role on the policy | Dependent · relationship 01 |
| Policy | B10M000690 |
| Date of birth | 10 Apr 1987 |
| Plan | SILVER HMO |
| Covered from | 26 Nov 2024 |
| Covered to | open |
Patient responsibility reported on the 835
| Reason | Adjustments | Amount reported |
|---|---|---|
| CARC 50 · Other | 1 | 528.45 |
| Total | 528.45 |
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0002878 | 15 Jul 2026 | 549.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0002876 | 8 Jun 2026 | 275.00 | MERIDIAN HEALTH PLAN | Not denied | — |
| CLM0002877 | 22 Mar 2025 | 813.00 | MERIDIAN HEALTH PLAN | CARC 50 · MEDICAL_NECESSITY | 0.00 |